What is histrionic personality disorder?

Exaggerated emotions and attention-seeking behavior characterize histrionic personality disorder (HPD). Individuals with this disorder often seek out constant approval and validation from others, and they may be seen as dramatic or superficial. As a result, histrionic personality disorder can cause significant distress and impairment in social, occupational, and other areas of functioning.

Common symptoms include rapidly changing emotions, overly concerned with physical appearance, persistently seeking attention and approval from others, being easily influenced by others, overly sexual behavior, extreme sensitivity to criticism or disapproval, and engaging in self-dramatization. In addition, someone with histrionic personality disorder may have trouble maintaining romantic relationships due to their tendency to be overbearing or flirtatious.

It's important to note that not everyone who experiences these behaviors has the disorder; they may show signs of high self-confidence and expressiveness.

While the exact cause of the disorder is unknown, it is likely due to a combination of genetic and environmental factors. Treatment for histrionic personality disorder typically involves talk therapy and medication. With treatment, most people with the mental health condition can improve their symptoms and live relatively normal and productive lives. [1]

Can HPD be treated with medication?

People with HPD often do not think anything is wrong with them as they have a distorted self-image, so getting them to see the problem may be challenging. Some patients will seek professional treatment when they experience depression due to a stressful event (e.g., a breakup) or when their behavior causes friction in relationships or at their workplace.

Medications may be beneficial in managing symptoms such as depression and anxiety associated with this disorder. Treating these symptoms may not necessarily treat the individual's HPD. Still, it makes it easier to cope and avoid developing other mental disorders such as depression and substance use disorder. The fact that HPD patients may be prone to suffering from these conditions makes it important for them to receive a differential diagnosis. [2]

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used medications for treating histrionic personality disorder, as they reduce feelings of depression and anxiety, which are often linked to the condition. They increase the levels of the chemical messenger serotonin in the brain. Some examples include fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).

Antipsychotics

Certain antipsychotic medicines, such as olanzapine (Zyprexa) or risperidone (Risperdal), reduce impulsivity and extreme behavior. Additionally, they regulate emotional responses that get overly intense in HPD.

Mood stabilizers

Mood stabilizers help with abrupt and drastic mood swings and impulsive behaviors, which are symptoms of individuals with HPD. Examples of these include lamotrigine (Lamictal) and carbamazepine (Tegretol).

How else can HPD be treated?

Psychotherapy or talk therapy can benefit individuals with HPD. However, it can be a complex process to start and maintain. In addition, people with HPD will not see the problem with their behavior and will not believe they need help.

Patients with HPD in therapy often have difficulty connecting genuinely to other people, instead tending to exaggerate their feelings in hopes of being the center of attention. As a result, they might misbehave with their therapist, sometimes even sexually approaching them during sessions.

This undesirable behavior can frustrate mental health professionals and those within the therapy group, leading to hesitancy or avoidance of sessions altogether. Patience must be exercised in therapy with individuals with HPD as they seek out connection while struggling to trust others. With the right environment, psychotherapy can provide a safe space and positive outcomes for individuals with this disorder.

Psychodynamic therapy helps HPD patients to become more self-aware and to understand their patterns of behavior. The past is used to inform the present, targeting underlying issues that may have led to HPD.

Cognitive behavioral therapy helps HPD patients develop skills to act more calmly, decrease impulsivity, and be more mindful of how their behavior affects others. Although group therapy has its pitfalls in individuals with HPD, being with people with the same personality traits can be an eye-opener. Noticing how their peers behave may help them recognize their faults and how this makes their loved ones feel. [3]

Resources:

  1. French, J. H., & Shrestha, S. (2022). Histrionic Personality Disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK542325/
  2. Histrionic Personality Disorder Treatment. (2021, October 14). Psych Central. https://psychcentral.com/disorders/histrionic-personality-disorder/treatment
  3. Sulz, S. Hysteria I: histrionic personality disorder. Der Nervenarzt, 81(7), 879–888. https://doi.org/10.1007/s00115-010-3016-6